Advance care planning is an ongoing process of thinking about, discussing, and documenting the medical care you’d want if you ever became too ill or injured to speak for yourself. It combines two things: conversations about your values and preferences, and legal paperwork that makes those preferences enforceable. Only about one third of adults in the United States complete this process in their lifetime, even though it’s recommended for every adult regardless of age or health status.
What the Process Actually Involves
Advance care planning isn’t a single event or a form you fill out once. It’s a repeating cycle of reflection, conversation, and documentation that ideally begins in early adulthood and gets revisited at major life milestones: starting a career, getting married, having children, receiving a new diagnosis, or entering retirement. The core idea is that your medical wishes should be clearly understood by the people who might need to act on them, whether that’s a family member, a doctor in an emergency room, or a surgeon preparing you for an operation.
The process typically starts with personal reflection. What matters most to you? Are there experiences or events you’d want every chance to be present for? Are there treatments you’ve seen a loved one go through that you’d want to avoid? The National Institute on Aging suggests framing these reflections in concrete terms, like “What matters most to me is ________” or thinking about a specific goal such as meeting a grandchild or maintaining independence at home.
From there, you share those reflections in conversations with family members, a trusted friend, or your doctor. These don’t need to be formal sit-downs. They can happen gradually, building over time. The final step is putting your wishes into legal documents so they carry weight in a medical setting.
The Key Legal Documents
The paperwork that comes out of advance care planning falls under the umbrella term “advance directives.” There are two main types, and they serve different purposes.
A living will is a legal document that spells out the specific medical treatments you do or don’t want if you can’t communicate during an emergency. It covers scenarios like whether you’d want to be placed on a ventilator, receive tube feeding, or undergo CPR, and under what conditions each choice applies.
A durable power of attorney for health care names a specific person, called your health care proxy, who is authorized to make medical decisions on your behalf when you can’t. This person doesn’t replace a living will. You can have both, and many people do. The proxy steps in to handle situations your living will didn’t anticipate, using their understanding of your values to guide decisions.
You can also name a surrogate decision maker more informally, though a formal durable power of attorney carries stronger legal standing. Some states have combined directive forms that merge the living will and proxy designation into a single document.
How POLST Forms Differ From Advance Directives
If you or a loved one has a serious illness, you may encounter a POLST form, which stands for Physician Orders for Life-Sustaining Treatment. Some states call it Medical Orders for Scope of Treatment. This is not the same thing as an advance directive, and the differences matter.
An advance directive is written by you, applies to any adult regardless of health, and expresses your preferences. A POLST is a set of actual medical orders written by a doctor (or in some states, a nurse practitioner or physician assistant). It’s specifically designed for people with serious illness or frailty, generally those whose doctor wouldn’t be surprised if they died within a year or two. Because it contains medical orders rather than preferences, a POLST is immediately actionable by paramedics and emergency responders in ways that a standard advance directive typically is not.
Another key difference: you’re responsible for making sure your advance directive travels with you and gets into your medical record. With a POLST, that responsibility falls on your health care team. Both documents can exist for the same person. The advance directive captures your broad values and goals across all stages of life, while the POLST translates your current medical situation into specific clinical orders.
When to Start and When to Update
A common misconception is that advance care planning is something for older adults or people facing a terminal diagnosis. Clinical guidance recommends starting in early adulthood and revisiting the conversation at each major life change. Getting married, having a child, being diagnosed with a chronic condition, losing a spouse, or retiring are all natural moments to check whether your documents still reflect your wishes.
Waiting until a hospitalization, serious accident, or catastrophic illness creates pressure to make complex decisions under stress, often without the clarity that earlier conversations would have provided. The goal is to treat advance care planning the way you’d treat updating a will or reviewing your insurance: a routine part of managing your life, not a crisis response.
How It Helps Families
Advance care planning doesn’t just protect the person whose wishes are documented. It significantly reduces the emotional burden on family members who might otherwise face agonizing decisions with no guidance. A systematic review of multiple studies found that when advance care planning had taken place, bereaved family members experienced lower levels of anxiety, stress, and depressive symptoms after a loved one’s death. Several of the reviewed studies showed measurable decreases in post-bereavement depression, with one finding a statistically significant reduction in depressive symptoms among African American family members whose loved ones had completed planning.
Without clear documentation or prior conversations, families often disagree about what their loved one would have wanted, which can fracture relationships at an already painful time. Having even an informal conversation on record helps remove the weight of guessing.
Medicare Coverage for Planning Conversations
If you’re covered by Medicare, advance care planning conversations with your doctor are a covered service. There’s no copay for the initial conversation during an annual wellness visit, and there’s no limit on how many times these conversations can be billed over your lifetime, as long as each new session reflects a change in your health status or wishes.
The visit needs to be voluntary and face-to-face, with your doctor documenting who participated, what was discussed, and any directives that were completed. Sessions are billed in 30-minute increments. If your health changes and your preferences shift, you can have follow-up conversations that are also covered.
Making Sure Your Documents Are Accessible
One of the biggest practical challenges with advance care planning is making sure your documents can actually be found when they’re needed. A study at one major medical center found that 55% of documented advance care planning discussions were not easily accessible in the electronic health record. They were buried in free-text progress notes from various departments rather than posted in a centralized, visible location.
To improve your odds, take a few concrete steps. Give copies of your advance directive to your health care proxy, your primary care doctor, and any specialists you see regularly. Ask your doctor’s office to scan the documents into your electronic health record and flag them prominently. If your state has an advance directive registry, consider registering there as well. Keep a card in your wallet or a note on your phone indicating that you have an advance directive and where it can be found. If you have a POLST, it should be kept in a visible location at home, often on the refrigerator, where emergency responders are trained to look for it.
The best advance care plan in the world is only useful if the right people can access it at the right moment. Treating storage and distribution as part of the planning process, not an afterthought, is what closes the gap between having wishes and having them honored.